WQ0045473_Application (FTSE)_20240501

U.�I( \ T�( �� �) ),` 107 Fayetteville St, Suite 200
Raleigh, NC 27601
Engineering I Consulting Office: 919.848.4399
Fax: [phone]
LETTER OF TRANSMITTAL
To: NCDEQ Date 4/30/2024
Wilmington Regional Office
Attn: Tyler Benson Enrionmental Specialist II DECEIVED/NCDENR/DWR
127 Cardinal Drive Extension
Wilmington NC 28405 MAY 01 2024
D=DIGITAL SUBMITAL
Water Quality Regional
OPerations section
Wilmington Regional office
Re: Sheetz at Shipyard Boulevard Job No.: 643-22
NCDEQ FTA - 1st Submittal
I am sending you the following item(s):
COPIES DATE NO. DESCRIPTION
1 4/30/2024 1 FTA 10-23_Signed (Original)
1 4/30/2024 2 FTSE 10-23_Signed (Secure Digital Signature)
1 4/30/2024 3 Sheetz at Shipyard Boulevard Site Plans
1 4/30/2024 4 Sheetz Water Usage Comparisons
1 4/30/2024 5 Cover Letter
1 4/30/2024 6 Application Fee ($600) Check u17622
4/30/2024 7 Sheetz, Inc. Company Documentation For Business Within NC &
1
Signing Authority
1 4/30/2024 8 8.5x11 USGS Topographic Map
1 4/30/2024 9 8.5x11 Aerial Location Map
1 4/30/2024 10 New Hanover County Book of Maps 74, Page 36
D 4/30/2024 11 Digital Copy of Above Files by Sharefile Link
These are transmitted as checked below:
❑ As requested ❑ For your use
® For approval
❑ For Signatures
❑ For review and comment ® For Submittal
Remarks:
Please let me know if you need any other information.
Copy to: File
Signed:
Mark Phillips

Burd, Tina J
From: Burd, Tina J
Sent: Friday, May 31, 2024 11:46 AM
To: [e-mail];[e-mail]
Cc: Cocanower,Jordan M; Tharrington, Tom
Subject: WQ0045473 - Sheetz at Shipyard Boulevard Sewer Extension
The Wilmington Regional Office of the Division of Water Resources, Water Quality Operations Section received the Fast
Track Sewer System Extension Application (FTA) and $600.00 fee for the subject project on May 1, 2024. The project has
been assigned to Jordan Cocanower, cc'd. Please note that the FTA has been revised and requests the applicant to
identify if this project is ARPA funded. if you omitted this information from the FTA, please contact Bryan Lievre, email
below, so that we can update our records. Otherwise,you will be contacted by the applicable staff member if additional
information is needed.
Staff Reviewer Counties Served
Tyler Benson Brunswick, Columbus, Duplin & Pender Contact Information
Jordan Cocanower Carteret, New Hanover&Onslow ©rdan nsan. de.cJ-rtc,gov
ty.-e r,be
Bryan Lievre cocanowert�deg nc nrly
All -ARPA Projects Only
Tom Tharrin ton Copy _b_r_y_an,lievre�deq nc�ov
g All—Coordinator, Please Co on All Emails tom.tharrinP-1 dep nc eov
1. Please provide a copy of the entire application in digital format to your assigned reviewer indicated abov
application and drawings should be provided as separate files. e. The
2. Please indicate in the subject line of the email the permit number(if available), name of the project, and county
where the project is located.
Please be advised that the construction of the proposed activities may not commence until the sewer permit is issued.
Best Regards,
Tina Burd
Administrative Associate 11
Wilmington Regional Office
Division of Environmental Assistance &Customer Service
Phone [phone]
New email: tina.b irdPdLq nc gov
NCDEQ
Wilmington Regional Office
127 Cardinal Drive Ext.
Wilmington, NC 28405
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Mark Phillips, PLA
Project Manager
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P\M D:�I( ,� ( rZ( )((? (�� o: 919 848 4399
Engineering I Consulting
April 17, 2024
PDG Project: 643-22
Tyler Benson
Environmental Specialist II
Wilmington Regional Office
Water Resources-Water Quality Regional Operations Section
127 Cardinal Drive Extension
Wilmington, NC 28405
RE: Fast Track Sewer System Extension Application Narrative
Sheetz at Shipyard Boulevard
Parcel ID: R06113-001-013-000
2455 Independence Boulevard
Wilmington, NC 28403
Dear Mr. Benson,
On behalf of Sheetz, Inc. (Applicant), please let this letter serve as a formal submittal
for a private sanitary sewer system extension for the Sheetz at Shipyard Boulevard
project located on Lot 15A with the address of 2455 Independence Boulevard,
Wilmington, NC 28403. Lot 15A is recorded on Book of Maps 74, Page 36 in New
Hanover County. Applicant proposes to construct 149.87 linear feet of 6-inch Schedule
40 PVC pipe. This private main will serve the Sheetz store on Lot 15B and the carwash
on Lot 15A. The site has an existing 6-inch sanitary sewer service stub with an invert
elevation of 36.19 feet that connects to the Cape Fear Public Utility Authority's public
sanitary sewer system having permit number WQ0018138.
For summarizing wastewater generated by this project, the proposed average daily
flow entering the system from the Sheetz store on Lot 15B, based on historical data
provided by Sheetz, is anticipated to be 2,000 GPD. See separate excel file attached
with this application for historical data over the past year.
Included with this submittal are the items listed below:
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1. Sheetz at Shipyard Boulevard Site Plans RECEIVED/NCDENR/DWR
Mk( 0 1 ?024
i
W?ter ouality Regional
CIPerations section
Wilmington Regional Office

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2. FTA 10-23 Form
3. FTSE 10-23 Form
4. Sheetz Water Usage Comparisons
5. Sheetz documentation from NC Secretary of State i
6. Review Fee ($600.00)
7. New Hanover County Book of Maps 74, Page 36
8. Color copy of USGS Topographic Map
9. Aerial location map showing general project area
We appreciate your consideration for the above requests and are available by email
or phone to discuss further as necessary.
Sincerely,
I
Mark Phillips, PLA j
Pabst Design Group, PA
107 Fayetteville St., Suite 200
Raleigh, NC 27601
919-810-3716
Cc: Brian Downs, Sheetz Engineering Permit Project Manager
Dan Pabst, PE, Pabst Design Group President
David Dailey, Cape Fear Public Utility Authority Project Manager I
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DWR State of North Carolina
Department of Environmental Quality
Division of Water Resources
Divlslon of Water Resources FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
INSTRUCTIONS FOR FORM:FTA 10-23&SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has
certified by a professional engineer and the applicant that the project meets the requirements of I SA NCAC 02T and the Division's
Minimum Design Criteria(Gravit�eWer&Ptimn Stations/Force Mains) and that plans, specifications and supportingbeen
have been prepared in accordance with 15A NCAC 02T 15A NCAC 02T.0300 Division policies,and ood en ineerin racy n s
documents
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305 n ties.
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, d
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria' These
sign
documents shall be immediately available upon request by the Division. P design
Projects that are deemed permitted(do not require a permit from the Division)are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process(must be submitted for full technical review):
➢ Projects that do not meet any part of the minimum design criteria(MDC)documents;
➢ Projects that involve more than one variance from the requirements of 15A NCAC 02T;
➢ Pressure sewer systems utilizing simplex septic tank-effluent pumps(STEPs)or simplex grinder pumps;
➢ Simplex STEP or simplex grinder pumps connecting to pressurized systems(e.g.force mains);
➢ Vacuum sewer systems.
General—When submitting an application,please use the following instructions as a checklist in order to ensure all required items
submitted. Adherence to these instructions and checking the provided boxes will help
amount of requested additional information.Failure to submit all required items will necessitate additional processing and review
time,and may result in return of the application. Unless otherwise noted,the Applicant antdshall uce a quicker review time and reduce the
the application and supporting documentation. submit one original and one copy of
A. One Original and One Copy(second copy may be digital)of Application and Su
pporting Documes
® Required unless otherwise noted.Signatures on original must be"wet ink"or secure digital signatures.
Please do not submit engineering design plans with the application unless specifically requested.
B. Cover Letter/Narrative Description(Required for All Application Packages):
® List all items included in the application package,as well as a brief description of the requested permitting action.
➢ Be specific as to the system type,number of homes served,flow allocation required,etc.
➢ Include the permit number/status of any other required sewer permits(downstreamhipstream)
➢ If necessary for clarity, include attachments to the application form.
➢ If the project is ftinded by American Rescue Plan Act(ARPA)funds,please include the ARPA project number in the cover
letter and in parentheses under Project Name(Section 1I.1.of the application).
C. Application Fee(All New and Modification Application Packages):
® Submit a check or money order in the amount of$600.00,dated no more than 90 days prior t aponjiwf ii%qlo vDWR
➢ Payable to North Carolina Department of Environmental Quality(NCDEQ)
D. Fast Track Application(Required for All Application Packages,Form FTA 10-23):
® Submit the completed and appropriately executed application. MAY .0-1 2024
➢ If necessary for clarity or due to space restrictions,attachments to the application may be made.
® If the Applicant Type in Item 1.2 is a corporation or company, wafer Quality Regional
Operations Section
North Carolina Secreta of State. P Y� Provide documentation it is r�gisterec� ortgn Regional
nessw with the
❑ If the Applicant Type in Item I.2 is a partnership or d/b/a,enclose a copy of the certificate filed with the Register of Deeds i
the county of business.
® The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters,agreements,etc. n
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional En rineer.
INSTRUCTIONS FOR FORM:FTA 10-23&SUPPORTING DOCUMENTATION
Page 1 of 3

® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T 0106(b). Per
15A NCAC 02T.0106(c),an alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T.0106(b).
E. Flow Tracking/Acceptance Form(Form: FTSE 10-23)(If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one year
prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-21 S 67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project-specific FTSE.
F. Site Maps(All Application Packages):
® Submit an 8.5-inch x I 1-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface waters.
➢ General location of the project components(gravity sewer,pump stations,&force main)
➢ Downstream connection points and pen-nit number(if known)for the receiving sewer
® Include an aerial location map showing general project area(such as street names or latitude/longitude)so that Division staff
can easily locate it in the field.
G. Existing Permit(Application Packages for Modifications to an Existing Permit):
❑ Submit a copy of the most recently issued existing permit.
❑ Include a descriptive and clear narrative identifying the previously permitted items to remain in the permit,items to be
added,and/or items to be modified(the application form itself should include only include items to be added/modified).The
narrative should also include whether any previously permitted items have been certified.
❑ The narrative should clearly identify the requested permitting action and accurately describe the sewers to be listed in
the final permit.
H. Power Reliability Plan(Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T 0305(h)(1),submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible with
the station. The Division will accept a letter signed by the applicant(see 15A NCAC 02T .0106(b))or proposed contractor,
stating that"the portable power generation unit or portable,independently-powered pumping units,associated appurtenances
and personnel are available for distribution and operation of this pump station."
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations'
storage capacities and the rotation schedule of the portable power source or pump, including travel timeframes,shall
be provided in the case of a multiple station power outage.(Required at time of certification)
1. Certificate of Public Convenience and Necessity(All Application Packages for Privately-Owned Public Utilities):
❑ Per 15A NCAC 02T 01 15(a)(1)provide the Certificate of Public Convenience and Necessity from the North Carolina Utilities
Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by the sewer
extension,or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division P blue Staff stating an application
for a franchise has been received and that the service area is contiguous to an existing franchis ar
is expected.
�1� �� val
J. Operational Agreements(Applications from HOA/POA and Developers for lots to be sold): MAY 4 1 •3l4
❑ Home/Property Owners'Associations
❑ Per ISA NCAC 02T O115(c),submit the properly executed Operational A reemcuit ORM: uatityflegional
❑ Per I5A NCAC 02T.0115(c),submit a copy of the Articles of Incorporation,Dec lara ions addii 15o "io tions awOffice
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T O1 ISlbl submit the properly executed Operational Agreement(FORM:DEV)
For more information, visit the Division's collection systems wehsite
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INSTRUCTIONS FOR FORM:FTA 10-23&SUPPORTING DOCUMENTATION
Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS,SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
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REGIONAL OFFICE ADDRESS COUNTIES SERVED j
Asheville Regional Office 2090 US Highway 70 Avery, Buncombe, Burke,Caldwell,Cherokee,
Water Quality Section Swannanoa, North Carolina 28778-8211 1 Clay, Graham, Haywood, Henderson,Jackson,
[phone] Macon, Madison, McDowell,Mitchell,Polk, j
[phone] Fax Rutherford, Swain,Transylvania,Yancey
Fayetteville Regional Office 225 Green Street Suite 714 Anson, Bladen, Cumberland,Harnett,Hoke,
Water Quality Section Fayetteville, North Carolina 28301-5095 Montgomery, Moore, Robeson, Richmond,
[phone] Sampson,Scotland
[phone] Fax
Mooresville Regional Office 610 E. Center Avenue Alexander, Cabarrus, Catawba,Cleveland,
Water Quality Section Mooresville, North Carolina 28115 Gaston, Iredell, Lincoln,Mecklenburg, Rowan,
[phone] Stanly, Union
[phone] Fax
Ralei h Re ional Office 3800 Barrett Drive Chatham, Durham, Edgecombe, Franklin,
Water Quality Section Raleigh, North Carolina 27609 Granville, Halifax, Johnston,Lee, Nash,
[phone] Northampton, Orange, Person,Vance,Wake,
[phone] Fax Warren,Wilson j
Washington Regional Office 943 Washington Square Mall Beaufort, Berne,Camden, Chowan,Craven,
Water Quality Section Washington, North Carolina 27889 Currituck, Dare,Gates, Greene,Hertford,Hyde,
[phone] Jones, Lenoir, Martin,Pamlico, Pasquotank,
[phone] Fax Perquimans, Pitt,Tyrrell,Washington,Wayne
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Wilmington Regional Office 127 Cardinal Drive Extension Brunswick,Carteret, Columbus,Duplin, New
Water Quality Section Wilmington, North Carolina 28405 Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office 450 W. Hanes Mill Road Alamance,Alleghany,Ashe,Caswell, Davidson, !
Water Quality Section Suite 300 Davie, Forsyth,Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105 Stokes, Surry,Watauga, Wilkes,Yadkin
[phone]
[phone] Fax
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INSTRUCTIONS FOR FORM: FTA 10-23 &SUPPORTING DOCUMENTATION Page 3 of 3
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State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23&SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: SHEETZ,INC.(company,municipality,HOA,utility,etc.)
2. Applicant type: ❑Individual ®Corporation ❑General Partnership ❑Privately-Owned Public Utility
❑Federal ❑State/County ❑Municipal ❑Other
3. Signature authority's name:Brian T.Dimes per 15A NCAC 02T.0106(b)
Title: Assistant Vice President of Real Estate
4. Applicant's mailing address: 5700 Sixth Avenue
City:Altoona State: PA Zip: 16602-
5. Applicant's contact information:
Phone number:[phone] Email Address:bdowns i4sheetz.com
II. PROJECT INFORMATION:
1. Project name: SHEETZ AT SHIPYARD BOULEVARD S eoJer C4_-n5;0n
2. Application/Project status: ®Proposed(New Permit) ❑Existing Permit/Project ❑ARPA funded
If a modification,provide the existing permit number:WQ00 and issued date: ,
For modifications,also attach a detailed narrative description as described in Item G of the checklist.
If new construction,but part of a master plan,provide the existing permit number:WQ00
3. County where project is located:New Hanover
4. Approximate Coordinates(Decimal Degrees):Latitude: 34.l 1'47"° Longitude:-77.54'30"°
5. Parcel ID(if applicable): R06113-001-013-000(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: P. Dan Pabst, PE License Number:032573 RECEIVED/NCDENR/DW1?
Finn:Pabst Design Group, PA MAY 01
2024
Mailing address: 107 Fayetteville St.
City:Raleigh State:NC Zip:27601- water ouai,ty Regional
operations Section
Phone number:[phone] Email Address:dpabstAyabstdesign.com Wilmington Regional omce
IV. WASTEWATER TREATMENT FACILITY(WWTF)INFORMATION:
1. Facility Name:M'Kean Maffitt(Southside)WWTP Permit Number:NPED NC 002973
Owner Name:Cape Fear Public Utility Authority
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0018138
2. Downstream(Receiving)Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection u System Permit Number(s)(if applicable): WQCS
Owner Name(s):—CEP `�
FORM: FTA 10-23 `��C' Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately-Owned Public Utility,has a Certificate of Public Convenience and Necessity been attached?
[:)Yes [:]No ®N/A
2. If the Applicant is a Developer of lots to be sold,has a Developer's Operational Agreement(FORM:DEV)been attached?
❑Yes ❑No ®N/A
3. If the Applicant is a Home/Property Owners'Association,has an HOA/POA Operational Agreement(FORM: HOA)and
supplementary documentation as required by 15A NCAC 02T.0115(c)been attached?
❑Yes [-]No ®N/A
4. Origin of wastewater:(check all that apply):
❑Residential(Individually Owned) ❑Retail(stores,centers,malls) ®Car Wash
❑Residential(Leased) ®Retail with food preparation/service ❑Hotel and/or Motels
❑School/preschool/day care ❑Medical/dental/veterinary facilities ❑Swimming Pool/Clubhouse
®Food and drink facilities ❑Church ❑Swimming Pool/Filter Backwash
❑Businesses/offices/factories ❑Nursing Home ®Other(Explain in Attachment)
5. Nature of wastewater: %Domestic 100%Commercial %Industrial(See 15A NCAC 02T.0103(201)
If Industrial,is there a Pretreatment Program in effect?❑Yes❑No
6. Has a flow reduction been approved under 15A NCAC 02T.0114(f)? ❑Yes ®No
➢ If yes,provide a cony of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f)) Daily Design Flow ''' No.of Units Flow
Other-Sheetz Gas Station(See Attached) 2000 gal/Day 1 2000 GPD
Sheetz Carwash(See Attached) 2280 gal/Day 1 2280 GPD
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
Total 4280 GPD
a See 15A NCAC 02T .01 14(b), (d), (e)(1)and(e)(2) for caveats to wastewater design flow rates(i.e. proposed unknown
non-residential development uses; public access facilities located near high public use areas; and residential property
located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined in G.S.42A-4).
b Per 15A NCAC 02T.0114(c),design flow rates for establishments not identified[in table 15A NCAC 02T.0114]shall be
determined using available flow data,water using fixtures,occupancy or operation patterns,and other measured data.
8. Wastewater generated by project:4.280 GPD(per 15A NCAC 02T.0114 and G.S. 143-215.1)
)i;- Do not include future flows or previously permitted allocations
If permitted flow is zero,please indicate why:
❑Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑Flow has already been allocated in Permit Number: Issuance Date:
❑Rehabilitation or replacement of existing sewers with no new flow expected
❑Other(Explain): RECEIVED/NCDENR/DWR
MAY 0I 2X..'4
Water Quality Regional
Operations section
FORM: FTA 10-23 Wilmington Regional Office Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA(If Applicable)-02T.0305&MDC(Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size(inches) Length (feet) Material
6 149.87 PVC SCH 40
➢ Section II&III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA(If Applicable)—02T.0305&AIDC(Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates(Decimal Degrees):Latitude: Longitude:- °
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day(firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s)per pump(s): gallons per minute(GPM)at feet total dynamic head(TDH)
5. Summarize the force main to be permitted(for this Pump Station):
Size(inches) Length(feet) Material RECEIVED/NCDENR/DWR
MAY 01 2024
Water Quality Regional
Operations section
Wilmington Regional Office
If any portion of the force main is less than 4-inches in diameter,please identify the method of solids reduction per
MDCPSFM Section 2.01C.l.b. ❑Grinder Pump ❑ Mechanical Bar Screen ❑Other(please specify)
6. Power reliability in accordance with 15A NCAC 02T.0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry- 15A NCAC 02T.0305(h)(1)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation,quick-connection receptacle and telemetry-
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations,an evaluation of all the pump stations'storage
capacities and the rotation schedule of the portable power source or pump,including travel timeframes,shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 10-23 Page 3 of 5

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1X. SETBACKS&SEPARATIONS (02B.0200 & 15A NCAC 02T.0305(f)): ,
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(t)& (g)? ® Yes ❑No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below(vertical) t8 inches
'Water mains(vertical-water over sewer preferred,including in benched trenches) t8 inches
'Water mains(horizontal) 10 feet l
Reclaimed water lines(vertical-reclaimed over sewer) t8 inches
Reclaimed water lines(horizontal-reclaimed over sewer) 2 feet
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"Any private or public water supply source,including any wells,WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water,and associated wetlands. 100 feet
**Waters classified WS(except WS-I or WS-V),B,SA,ORW,HQW,or SB from normal
high water(or tide elevation)and wetlands associated with these waters(see item iX.2) 50 feet
**Any other stream, lake,impoundment,or ground water lowering and surface drainage
ditches,as well as wetlands associated with these waters or classified as WL. 10 feet
Any building foundation(horizontal) 5 feet
Any basement(horizontal) 10 feet
Top slope of embankment or cuts of 2 feet or more vertical height 10 feet
Drainage systems and interceptor drains 5 feet
Any swimming pools 10 feet
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Final earth grade(vertical) 36 inches
➢ If noncompliance with 02T.0305(f)or(a).see Section X.1 of this application
*15A NCAC 02T.0305(g)contains alternatives where separations in 02T.0305(f)cannot be achieved.Please check"yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
2. Does this project comply with the minimum separation requirements for water mains? ®Yes ❑No ❑N/A
➢ If no,please refer to 15A NCAC 18C.0906(f)for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE,verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ®Yes ❑No ❑N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ®Yes Basin name:Cape Fear ❑No k4
If yes,does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑No
➢ This includes Trout Buffered Streams per 15A NCAC 213.0202 4
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑Yes ®No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6)(additional permits/certifications)? ®Yes ❑No
Per 15A NCAC 02T.0105(c)(6),directly related environmental permits or certification applications must be being prepared,
have been applied for,or have been obtained. Issuance of this permit is contingent on issuance of dependent permits(erosion
and sedimentation control plans,stormwater management plans,etc.).
7. Does this project include any sewer collection lines that are deemed"high-priority?" ❑ Yes ®No
Per 15A NCAC 02T.0402,"high-priority sewer"means any aerial sewer,sewer contacting surface waters,
siphon,or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes,include an attachment with details for each line,including type(aerial line,size,material,and location).
i
High priority lines shall be inspected by the permittee or its representative at least once every six-months and
inspections documented per 15A NCAC 02T.0403(a)(5)or the permittee's individual System-Wide Collection permit.
FORM: FTA 10-23 Page 4 of 5

�I
X. CERTIFICATIONS: {�('Y�l /�ts�kfj
1. Does the submitted system comply with le Pennittine of Pump Stations
and Force Mains(latest version), and the TzA Dn)as applicable?
If no, for projects requiring a single va ��� �f'lo"� Ot C q—CeE a Design Request application
(VADC 10-14) and supporting docume P the request will be issued
concurrently with the approval of the val may be subiect to longer
review times.For proiects requiring tw mined by the Division to be a
significant portion of the project,the fu
2. Professional Engineer's Certification:
tl
NA2D gout_r AO
(Professional Engineer's name from Application to m Application Item 11.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications,engineering calculations,and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers(latest version),and the Minimum Design Criteria for the Fast-Track Permitting
of Pump Stations and Force Mains(latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly snakes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed$10,000,as well as civil penalties up to$25,000 per violation.Misrepresentation of the application
information,including failure to disclose any design non-compliance with the applicable Rules and design criteria,may subject
the North Carolina-licensed Professional Engineer to referral to the licensing board.(21 NCAC 56.0701)
.......................................................................................
.
mrrziR►nt
North Carolina Professional Engineer's seal,signature,and date: ,��H CA R
............
O
a�.•• ''• %y
�QUO
SEAL
03z57'3
tu1;i �
. ........ . ........:
3. Applicant's Certification per 15A NCAC 02T.0106(b): 4-13 2-j
I, y'MN Q I ocA J ,attest that this application for 5141510 2. AM 54A1P` MZ F)ouLEVACD
(Signature Authority Name QD1n Application Item 1.3.) (Project Name from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non-discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties,injunctive relief,and/or criminal prosecution. I will snake no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly snakes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed$10,000 as well as civil penalties tip to$25,000 per violation.
Signature: ` _- Date:
FORM: FTA 10-23 Page 5 of 5

' 1
State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Sheetz, Inc.
Project Name for which flow is being requested: Sheetz at Shipyard
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all puarp
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: M'Kean Maffitt(Southside)WWTP
b. WWTP Facility Permit#: NPDES NC 0023973
All flows are in MGD
c. WWTP facility's permitted flow 12.000
d. Estimated obligated flow not yet tributary to the WWTP 3.730
e. WWTP facility's actual avg. flow 8.044
f. Total flow for this specific request 0.004280
g. Total actual and obligated flows to the facility 11.779
h. Percent of permitted flow used 98.2
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design
Average Approx. Obligated,
Pump Pump Daily Current Not Yet Total Current
Station Station Firm Flow** Avg. Daily Tribuiary Flow Plus
(Name or Permit Capacity,* (Firm/p fl, Flow, Daily Flow, Obligated Available
Number) No. MGD MGD MGD MGD Flow Capacity***
25 WQ0016783 2.160 0.864 0.107 0.064 0.171 0.693
*The Firm Capacity(design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
**Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5,per Section 2.02(A)(4)(c)of the Minimum Design Criteria.
***A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is<0.
Downstream Facility Name (Sewer): Cape Fear Public Utility Authority RECEIVED/NMENR/DWR
Downstream Permit Number:
MAY 01 2024
Page 1 of 6
Water Quality Regional
FTSE 1 -18 operations section
Wilmington Regional Office

1
III. Certification Statement:
I Jeff Theberge, CFPUA Eng. Mgr certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
3e#-1hebeive 04/30/2024
Jeff Theberge(Apr 30,202 9:15 EDT)
Signing Official Signature Date
Engineering Manager
Title of Signing Official
i
Page 2 of 6
FTSE 10-18

Flow Tracking for Sewer Extension Permit
Application
Final Audit Report 2024-04-30
Created: 2024-04-30
By: Jeff Theberge([e-mail])
Status: Signed
Transaction ID: CBJCHSCAABAAHNptM27Zr74ZgXgOn4ZZZEzK5xOLWWb
"Flow Tracking for Sewer Extension Permit Application" History
L-) Document created by Jeff Theberge ([e-mail])
2024-04-30-1:14:57 PM GMT
C'y Document emailed to Jeff Theberge ([e-mail]) for signature
2024-04-30-1:15:00 PM GMT
b© Document e-signed by Jeff Theberge ([e-mail])
E-signature obtained using URL retrieved through the Adobe Acrobat Sign API
Signature Date:2024-04-30-1:15:32 PM GMT-Time Source:server
Agreement completed.
2024-04-30-1:15:32 PM GMT
0 Adobe Acrobat Sign

0 BUSINESS CORPORATION ANNUAL REPORT
1/612022
NAME OF BUSINESS CORPORATION: Sheetz Inc.
0597312 Fling Office Use Only
SECRETARY OF STATE ID NUMBER: STATE OF FORMATION: PA E-Filed Annual Report
0597312
REPORT FOR THE FISCAL YEAR END: 9/30/2023 CA202400202145
1/2/2024 02:30
SECTION A: REGISTERED AGENT'S INFORMATION Changes
1. NAME OF REGISTERED AGENT: Corporation Service Company
2.SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS&COUNTY 4.REGISTERED AGENT OFFICE MAILING ADDRESS
2626 Glenwood Ave Ste 550 2626 Glenwood Ave Ste 550
Raleigh, NC 27608 Wake County Raleigh, NC 27608
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Retail Convenience Store
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3.PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
5700 Sixth Avennue 5700 Sixth Avennue
Altoona, PA 1 6602-1 1 1 1 Altoona, PA 1 6602-1 1 1 1
6.Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran-owned small business
❑ The company is a service-disabled veteran-owned small business
SECTION C:OFFICERS(Enter additional officers in Section E.)
NAME: Steven P Augustine NAME: Stephanie Doliveira NAME: Michael A Lacesa
TITLE: Assistant Secretary TITLE: Vice President TITLE: Assistant Secretary
ADDRESS: ADDRESS: ADDRESS:
5700 Sixth Ave 5700 Sixth Ave 5700 Sixth Ave
Altoona, PA 16602 Altoona, PA 16602 Altoona, PA 16602
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business
entity.
t3rian King 1/2/2024
SIGNATURE DATE
Form must be signed by an officer listed under Section C of this form.
Brian King Vice President
Print or Type Name of Officer Print or Type Title of Officer
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 27626-0525

SECTION E: ADDITIONAL OFFICERS
NAME: Travis T Sheetz NAME: Robert Jochen NAME: Kyle Smith
TITLE: President TITLE: Assistant Secretary TITLE: Assistant Secretary
ADDRESS: ADDRESS: ADDRESS:
5700 Sixth Ave 5700 Sixth Ave 5700 Sixth Ave
Altoona, PA 16602 Altoona, PA 16602 Altoona, PA 16602
NAME: Darrin Pohar NAME: Anna Caporuscio NAME: Charlie Campbell
TITLE: Vice President TITLE: Assistant Secretary TITLE:
Vice President
ADDRESS: ADDRESS: ADDRESS:
5700 Sixth Ave 5700 Sixth Ave 5700 Sixth Ave
Altoona, PA 16602 Altoona, PA 16602 Altoona, PA 16602
NAME: Trevor Walter NAME: Dan Coffin NAME: Emily Sheetz-Mandel
TITLE: Vice President TITLE: Vice President TITLE:
Vice President
ADDRESS: ADDRESS: ADDRESS:
5700 Sixth Ave 5700 Sixth Ave 5700 Sixth Ave
Altoona, PA 16602 Altoona, PA 16602 Altoona, PA 16602
NAME: Ryan Sheetz NAME: Gary Zimmerman NAME: Joseph S Sheetz
TITLE: Vice President TITLE: Vice President TITLE: Chairman Of The Board
ADDRESS: ADDRESS: ADDRESS:
5700 Sixth Ave 5700 Sixth Ave 5700 Sixth Ave
Altoona, PA 16602 Altoona, PA 16602 Altoona, PA 16602
NAME: Adam Sheetz NAME: Brian King Name:John Campbell
TITLE: Vice President TITLE: Vice President TITLE:
Vice President
ADDRESS: ADDRESS: ADDRESS:
5700 Sixth Ave 5700 Sixth Avenue 5700 Sixth Avenue
Altoona, PA 16602 Altoona, PA 16602 Altoona, PA 16602
NAME,.-.Brian binges ' NAME: NAME:
TITLE: Vice President TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
5700 Sixth Avenue
Altoona, PA 16602

Nor". Carolina Secretary of State Search Results https:/hvww.sosnc.gov/online_services/search/Business_Registration_R...
- File an Annual Report/Amend an Annual Report • Upload a PDF Filing - Order a Document Online -
Add Entity to My Email Notification List - View Filings - Print a Pre-Populated Annual Report form - Print
an Amended a Annual Report form
Business Corporation
Legal Name
Sheetz Inc.
Information
Sosld: 0597312
Status: Current-Active O
Date Formed: 7/12/2001
Citizenship: Foreign
State of Incorporation: PA
Fiscal Month: September
Annual Report Due Date: January 15th
CurrentAnnual Report Status:
Registered Agent: Corporation Service Company
Addresses
Reg Office Reg Mailing Mailing
2626 Glenwood Ave Ste 550 2626 Glenwood Ave Ste 550 5700 Sixth Avennue
Raleigh, NC 27608 Raleigh, NC 27608 Altoona, PA 16602-1111
Principal Office
5700 Sixth Avennue
Altoona, PA 16602-1111
Officers
Assistant Secretary Vice President Vice President Assistant Secretary
Steven P Augustine Charlie Campbell John Campbell Anna Caporuscio
5700 Sixth Ave 5700 Sixth Ave 5700 Sixth Avenue 5700 Sixth Ave
Altoona PA 16602 Altoona PA 16602 Altoona PA 16602 Altoona PA 16602
1 of 1/24/2024,2:18 PM

Nor Carolina Secretary of State Search Results https://www.sosnc.gov/online_services/search/Btisiiiess_Registratioii_R...
Vice President Vice President Vice President Assistant Secretary
Dan Coffin Brian Dinges Stephanie Doliveira Robert Jochen
5700 Sixth Ave 5700 Sixth Avenue 5700 Sixth Ave 5700 Sixth Ave
Altoona PA 16602 Altoona PA 16602 Altoona PA 16602 Altoona PA 16602
Vice President Assistant Secretary Vice President Vice President
Brian King Michael A Lacesa Darrin Pohar Adam Sheetz
5700 Sixth Avenue 5700 Sixth Ave 5700 Sixth Ave 5700 Sixth Ave
Altoona PA 16602 Altoona PA 16602 Altoona PA 16602 Altoona PA 16602
Chairman of the Board Vice President President Vice President
Joseph S Sheetz Ryan Sheetz Travis T Sheetz Emily Sheetz-Mandel
5700 Sixth Ave 5700 Sixth Ave 5700 Sixth Ave 5700 Sixth Ave
Altoona PA 16602 Altoona PA 16602 Altoona PA 16602 Altoona PA 16602
Assistant Secretary Vice President Vice President
Kyle Smith Trevor Walter Gary Zimmerman
5700 Sixth Ave 5700 Sixth Ave 5700 Sixth Ave
Altoona PA 16602 Altoona PA 16602 Altoona PA 16602
Stock
2 42 1/24/2024,2:18 PM

Lit
WQ0018138
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Mark Phillips, PLA
ik�
Project Manager
mphillipsapabstdesign.com
o: 919 848 4399
PM T n.w-N Gi o ) m
Engineering I Consulting
June 3, 2024
PDG Project: 643-22
Tyler Benson
Environmental Specialist II
Wilmington Regional Office
Water Resources-Water Quality Regional Operations Section
127 Cardinal Drive Extension
Wilmington, NC 28405
RE: Fast Track Sewer System Extension Requested Design Flow Rate Narrative
Sheetz at Shipyard Boulevard
Parcel ID: RO6113-001-013-000
2455 Independence Boulevard
Wilmington, NC 28403
Dear Mr. Benson,
On behalf of Sheetz, Inc. (Applicant), please let this letter serve as justification for the
requested wastewater design flow rates.
To obtain a 2,280 gpd expected flow for the carwash, the Applicant averaged their
daily usage from 149 car washes. This data set only included car washes with a
dedicated water meter for the car wash. The data utilizes sites across their 6-state
footprint and contains 12 months of utility billing history. Their historical usage could
be higher than the flows specified in 15A NCAC 02T 0.114 due to the popularity of their
stores or even due to the type of equipment utilized inside the car washes. Regardless
of the reason the Applicant prefers to hold the higher gpd to match their expected
usage.
To obtain the 2,000 gpd expected flow for the Sheetz gas station, the Applicant
averaged the daily usage from 293 of their 720 stores. This data set only included
stores with a dedicated water meter for the building. The data utilizes similarly sized j
stores across their 6-state footprint and contains 12 months of utility billing history. '
Applicant eliminated their older smaller stores and their larger truck diesel stores as
both would skew the expected usage. Internal to their building they utilize a large

number of flow reduction fixtures which helps bring their water usage below the flows
specified in 15A NCAC 02T 0,114.
We appreciate your consideration for the above requests and are available by email
or phone to discuss further as necessary.
Sincerely,
40 �
Mark Phillips, PLA
Pabst Design Group, PA
107 Fayetteville St., Suite 200
Raleigh, NC 27601
919-810-3716
Cc: Brian Downs, Sheetz Engineering Permit Project Manager
Dan Pabst, PE, Pabst Design Group President
David Dailey, Cape Fear Public Utility Authority Project Manager
f
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